Construction of Integrated Technology for Physical and Mental Health in Conflict-Affected Middle Eastern Regions
A Confirmatory Factor Analysis of the Dimensions of Digital Innovation, Infrastructure Readiness, User Competency, and Sustainability
DOI:
https://doi.org/10.59680/ventilator.v3i4.2114Keywords:
Confirmatory Factor Analysis, Digital Health Technology, Middle East Conflict, System Sustainability, TelepsychologyAbstract
This study offers a comprehensive analysis of the integrated technology construct connecting physical and mental health services in conflict-affected Middle Eastern regions by employing confirmatory factor analysis within a Structural Equation Modelling approach. The research is based on 1,124 documents on digital health technology implementation published between 2017 and 2024 across fourteen countries. The measurement model demonstrates strong goodness-of-fit, evidenced by chi-square/df = 1.847, CFI = 0.971, TLI = 0.965, RMSEA = 0.041, and SRMR = 0.034, thereby confirming the structural soundness of the proposed framework. The analysis identifies four core dimensions—Digital Innovation (lambda = 0.893, CR = 13.672), Infrastructure Readiness (lambda = 0.847, CR = 12.184), User Competency (lambda = 0.819, CR = 11.453), and Sustainability (lambda = 0.865, CR = 12.738)—all significant at p < 0.001. Reliability indices are robust, with Cronbach's Alpha between 0.876 and 0.934, Composite Reliability ranging from 0.891 to 0.947, and Average Variance Extracted between 0.661 and 0.798, indicating strong internal consistency. The findings expand earlier digital health frameworks proposed by Mechael (2009) and Labrique et al. (2013) by emphasizing sustainability as a key component in conflict settings marked by limited resources. In contrast to Aranda-Jan et al. (2014), which addresses general technology adoption, this study underscores specific challenges in integrating both mental and physical health services in humanitarian contexts, thereby responding to the gap highlighted by Naslund et al. (2017) regarding fragmented digital mental health initiatives in crisis environments.
References
Ahmed, S. K. (2023). The role of digital health in revolutionizing healthcare in conflict settings. Lancet Digital Health. https://doi.org/10.1177/20552076231218158
Andersson, G. (2016). Internet-delivered psychological treatments. Annual Review of Clinical Psychology, 12(1), 157–179. https://doi.org/10.1146/annurev-clinpsy-021815-093006
Aranda-Jan, C. B., Mohutsiwa-Dibe, N., & Loukanova, S. (2014). Systematic review on what works, what does not work and why of implementation of mobile health (mHealth) projects in Africa. BMC Public Health, 14(1), 188. https://doi.org/10.1186/1471-2458-14-188
Bowsher, G., Veale, S., & Weir, K. (2021). eHealth for service delivery in conflict: A narrative review of the evidence. Health Policy and Planning, 36(6), 974–988. https://doi.org/10.1093/heapol/czab042
Davis, F. D. (1989). Perceived usefulness, perceived ease of use, and user acceptance of information technology. MIS Quarterly, 319–340. https://doi.org/10.2307/249008
DeRenzi, B., Borriello, G., Jackson, J., Kumar, V. S., Parikh, T. S., Virk, P., & Lesh, N. (2011). Mobile phone tools for field-based healthcare workers in low-income countries. Mount Sinai Journal of Medicine, 78(3), 406–418. https://doi.org/10.1002/msj.20256
Kakria, P., Tripathi, N. K., & Kitipawang, P. (2015). A real-time health monitoring system for remote cardiac patients using smartphones and wearable sensors. International Journal of Telemedicine and Applications, 2015, Article 373474. https://doi.org/10.1155/2015/373474
Labrique, A. B., Vasudevan, L., Kochi, E., Fabricant, R., & Mehl, G. (2013). mHealth innovations as health system strengthening tools: 12 common applications and a visual framework. Global Health: Science and Practice, 1(2), 160–171. https://doi.org/10.9745/GHSP-D-13-00031
Lee, J. W. (2024). Diffusion of innovations. In Encyclopedia of sport management (pp. 266–268). Edward Elgar Publishing. https://doi.org/10.4337/9781035317189.ch157
Lee, S., Cho, Y. M., & Kim, S. Y. (2017). Mapping mHealth and mobile penetrations in sub-Saharan Africa for strategic regional collaboration in mHealth scale-up: An application of exploratory spatial data analysis. Globalization and Health, 13(1), 63. https://doi.org/10.1186/s12992-017-0286-9
Leon, N., Schneider, H., & Daviaud, E. (2012). Applying a framework for assessing the health system challenges to scaling up mHealth in South Africa. BMC Medical Informatics and Decision Making, 12(1), 123. https://doi.org/10.1186/1472-6947-12-123
McCool, J., Dobson, R., Whittaker, R., & Paton, C. (2022). Mobile health (mHealth) in low- and middle-income countries. Annual Review of Public Health, 43(1), 525–539. https://doi.org/10.1146/annurev-publhealth-052620-093850
Mechael, P. N. (2009). The case for mHealth in developing countries. Innovations: Technology, Governance, Globalization, 4(1), 103–118. https://doi.org/10.1162/itgg.2009.4.1.103
Mehl, G., & Labrique, A. (2014). Prioritizing integrated mHealth strategies for universal health coverage. Science, 345(6202), 1284–1287. https://doi.org/10.1126/science.1258926
Melnick, E. R., Dyrbye, L. N., Sinsky, C. A., Trockel, M., West, C. P., Nedelec, L., ... & Shanafelt, T. (2020). The association between perceived electronic health record usability and professional burnout among US physicians. Mayo Clinic Proceedings, 95(3), 476–487. https://doi.org/10.1016/j.mayocp.2019.09.024
Mistry, H. (2012). Systematic review of studies of the cost-effectiveness of telemedicine and telecare: Changes in the economic evidence over twenty years. Journal of Telemedicine and Telecare, 18(1), 1–6. https://doi.org/10.1258/jtt.2011.110505
Musaiger, A. O., Hassan, A. S., & Obeid, O. (2011). The paradox of nutrition-related diseases in the Arab countries: The need for action. International Journal of Environmental Research and Public Health, 8(9), 3637–3671. https://doi.org/10.3390/ijerph8093637
Peiris, D., Praveen, D., Johnson, C., & Mogulluru, K. (2014). Use of mHealth systems and tools for non-communicable diseases in low- and middle-income countries: A systematic review. Journal of Cardiovascular Translational Research, 7(8), 677–691. https://doi.org/10.1007/s12265-014-9581-5
Piette, J. D., Lun, K. C., Moura Jr., L. A., Fraser, H. S., Mechael, P. N., Powell, J., & Khoja, S. R. (2012). Impacts of e-health on the outcomes of care in low- and middle-income countries: Where do we go from here? Bulletin of the World Health Organization, 90, 365–372. https://doi.org/10.2471/BLT.11.099069
ReliefWeb / United Nations Reporting. (2025). Sudan and other crisis reporting: displacement and humanitarian impact. ReliefWeb. https://reliefweb.int/report/world/world-refugee-day-number-displaced-people-reaches-record-1232-million
Safeguarding Health in Conflict Coalition. (2024). 2023 attacks on health care in war zones (Coalition Report). Physicians for Human Rights / SHCC. https://phr.org/news/2023-attacks-on-health-care-in-war-zones-most-ever-documented-safeguarding-health-in-conflict-coalition-shcc-report/
World Health Organization. (2025). WHO health emergency appeal and snapshot 2025. WHO.
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